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首页> 外文期刊>British journal of neurosurgery >Ventriculoperitoneal shunt survival in children who require additional abdominal surgery-are our estimations of the additional risk accurate?
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Ventriculoperitoneal shunt survival in children who require additional abdominal surgery-are our estimations of the additional risk accurate?

机译：需要进行额外腹部手术的儿童的心室腹膜分流存活-我们对额外风险的估计是否准确？

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Objective. Ventriculoperitoneal shunt (VPS)-dependent children require abdominal surgery for many reasons. Our objective was to quantify the risk of abdominal surgery on VPS survival and to determine whether timing of abdominal intervention impacts on shunt outcome. Methods. Retrospective data collection was performed on all children undergoing primary VPS insertion or revision over 2 years (1/1/08-31/12/10). All shunt interventions were categorised into two groups: those undergoing additional "Abdominal surgery" (AS) versus those undergoing "Shunt-only" (SO). Kaplan-Meier survival curves were devised and analysed using log-rank. In the AS group, we compared shunt survival for shunts inserted at various "Time from abdominal surgery" (TAS). We conducted a control analysis to compare shunt survival in AS, SO and a control "clean general surgery" (SG) group. Chi-squared test was used to determine the cause of shunt failure in these three groups. Results. Three hundred and forty two shunts from 109 patients were included. Twenty patients contributed 118 shunts to the AS group. Median shunt survival was 3.68 months (95% CI = 1.01-6.47) and 22.6 months (95% CI = 8.76-36.4) in the AS and SO groups, respectively (log-rank = 16.6, p < 0.001). For each additional abdominal intervention, the risk of shunt failure increased by 55.4% (p < 0.001). Median shunt survival was 1.48 months (95% CI = 0.00-3.09, p < 0.001), if shunt insertion occurred within 1 year of abdominal surgery. Beyond 1 year, median shunt survival increased five-fold to 7.65 months (95% CI = 0.00-20.1, log-rank = 23.2, p < 0.001). There was a 29% reduction in risk of shunt failure per year interval between a shunt and an abdominal surgery (95% CI = 0.11-0.44, p < 0.005). Our control analysis confirmed that shunts in the AS group had worst survival and infection (p < 0.001). Conclusion. Additional abdominal surgery shortens VPS lifetime and increases risk of infection. Delaying abdominal surgery from a shunt intervention or vice versa by at least 1 year may prolong shunt survival.
机译：目的。依赖心室腹腔分流（VPS）的儿童由于许多原因需要进行腹部手术。我们的目的是量化腹部手术对VPS存活的风险，并确定腹部介入手术的时机是否对分流结局产生影响。方法。回顾性数据收集了所有在2年内（1/1 / 08-31 / 12/10）接受初次VPS或修订的儿童。所有的分流干预措施都分为两类：接受额外“腹部手术”（AS）的患者与接受“仅分流术”（SO）的患者。设计了Kaplan-Meier生存曲线并使用对数秩进行了分析。在AS组中，我们比较了在各种“来自腹部手术的时间”（TAS）插入的分流器的分流存活率。我们进行了对照分析，以比较AS，SO和对照“清洁普外科”（SG）组的分流存活率。卡方检验用于确定这三组并联失败的原因。结果。包括来自109名患者的342次分流。 20名患者为AS组贡献了118次分流。 AS组和SO组的中位分流生存中位数分别为3.68个月（95％CI = 1.01-6.47）和22.6个月（95％CI = 8.76-36.4）（log-rank = 16.6，p <0.001）。每增加一次腹部干预，分流失败的风险就会增加55.4％（p <0.001）。如果在腹部手术后1年内发生分流术，则分流术中位生存期为1.48个月（95％CI = 0.00-3.09，p <0.001）。超过1年，分流中位生存期增加了五倍，达到7.65个月（95％CI = 0.00-20.1，对数秩= 23.2，p <0.001）。在分流术和腹部手术之间，每年间隔分流失败的风险降低了29％（95％CI = 0.11-0.44，p <0.005）。我们的对照分析证实，AS组的分流器的生存和感染情况最差（p <0.001）。结论。额外的腹部手术会缩短VPS寿命并增加感染的风险。将分流术的腹部手术延迟至少1年，反之亦然，至少可以延长分流器的生存时间。

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